Preventive Care and Screening: Risk-Stratified Cholesterol – Fasting Low Density Lipoprotein (LDL-C)

Last updated: May 18, 2016

CMS Measure ID: CMS64v4
Version: 4
NQF Number: None
Measure Description:

Percentage of patients aged 20 through 79 years who had a fasting LDL-C test performed and whose risk-stratified fasting LDL-C is at or below the recommended LDL-C goal.

Initial Patient Population:

All patients 20 through 79 years of age before the beginning of the measurement period

Denominator Statement:

Denominator 1: (High Risk)
All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed during the measurement period and have CHD or CHD Risk Equivalent OR 10 year Framingham risk > 20%

Denominator 2: (Moderate Risk)
All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed during the measurement period and have 2 or more Major CHD Risk Factors OR 10 year Framingham Risk 10-20%.

Denominator 3: (Low Risk)
All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed up to 4 years prior to the current measurement period and have 0 or 1 Major CHD Risk Factors OR 10 year Framingham risk <10%.

** For Denominator 2 and Denominator 3, HDL-C > or equal to 60 mg/dL subtracts 1 risk from the above (This is a negative risk factor.)

Denominator Exclusions:

Patients who have an active diagnosis of pregnancy

OR

Patients who are receiving palliative care

Numerator Statement:

Numerator 1:
Patients whose most recent fasting LDL-C test result is in good control, defined as <100 mg/dL

Numerator 2:
Patients whose most recent fasting LDL-C test result is in good control, defined as <130 mg/dL

Numerator 3:
Patients whose most recent fasting LDL-C test result is in good control, defined as <160 mg/dL

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: Centers for Medicare & Medicaid Services
Domain: Effective Clinical Care
Next Version: Preventive Care and Screening: Risk-Stratified Cholesterol -Fasting Low Density Lipoprotein (LDL-C)
Measure Score: Proportion
Score Type: Process
Improvement Notation:

Higher score indicates better quality.

Guidance:

This is a two -part measure which is paired with CMS 61: Preventive Care and Screening: Cholesterol – Fasting Low Density Lipoprotein (LDL-C) Test Performed. If the fasting LDL-C results are documented this measure CMS 64 should also be reported.

To be eligible for performance calculations, patients must have at least one face-to -face visit with the eligible professional during the measurement period and have one fasting LDL-C performed during the same measurement period with the exception of patients with 0 or 1 risk factors who may have an fasting LDL-C performed up to four (4) years prior to the current measurement period. To meet the numerator criteria for this measure, the patient’s fasting LDL-C (low density lipoprotein) meets or exceeds the recommended LDL-C goal.

Specifications

External Resources